Cough

  • See also 

    Pertussis/Whooping cough
    Asthma
    Foreign body
    Parent Information Sheet

    Background

    Young children develop 6-12 respiratory tract infections per year, usually accompanied by cough. In most children, the cough is self-limiting (1-3 weeks), but it is sometimes prolonged. In general, if a child presents with a history ofdaily cough for greater than 3 weeks duration, one needs to consider other possible causes.

    • The predominant cause of cough in children of all ages is upper respiratory infection, but other causes are more likely to be age related.
      Infants may have structural abnormalities of the airways, tracheo-oesophageal fistula, vascular rings or other anomalies.
      Toddlers may have a foreign body or asthma.
      Children may have asthma or chronic rhinitis.
      Adolescents may have a cough caused by smoking or psychogenic factors.
    • Although children with asthma can present with cough, cough alone will uncommonly be due to asthma and it is important to look for other features to support this diagnosis.
    • A productive cough is abnormal in children and usually has an identifiable specific cause.

    Assessment

    History

    • Distinguish recurrent episodes from continuous cough.
    • Ask about 
      • Onset (eg. sudden onset of cough without a viral prodrome may suggest foreign body inhalation).
      • Type of cough (eg. paroxysmal cough may suggest pertussis, chlamydia, or foreign body. Honking cough may suggest psychogenic cough).
      • Pattern of cough (eg. cough which is absent during sleep is suggestive of habit cough).
      • Symptoms of sinusitis, chronic rhinitis, atopic conditions and asthma.
      • Exercise tolerance.
      • Any other medical concerns.
      • Exposure to passive smoking.

    Examination

    • Look for evidence of any abnormalities on general and respiratory examination, including fever, failure to thrive, clubbing, tachypnoea, wheeze, differential air entry or crepitations.

    Investigations

    Investigations should be performed as indicated by clinical suspicion.

    Management

    Well child, normal examination

    • If the child is otherwise well, with normal examination, reassurance and "watch and see" approach can be adopted. 
    • There is no evidence that cough medicines, decongestants, antihistamines or antibiotics have a role in treatment. 
    • Avoid exposure to irritants such as cigarette smoke (see also  smoking). 
    • Arrange follow up with LMO or paediatrician in 2-3 weeks.

    Unwell child or abnormal examination 

    • These children will need further investigation and treatment and senior advice should be sought.

    Persistent cough - flow chart

      Persistent cough


    Parent Information sheet
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